4
February
#WorldCancerDay
#WeCanICan

The State of Oncology in Rwanda: A conversation with the Minister of Health

Each year on 4 February, the world recognizes cancer as a global health threat, the World Health Organization (WHO) and International Agency for Research on Cancer (IARC) supports Union for International Cancer Control (UICC) and member states to promote ways to ease the global burden of cancer.

With the recent adoption of the UN Sustainable Development Goals (SDGs), we are entering a new era for global health. Now more than ever there is a need for a global commitment to help drive advancements in cancer and non-communicable diseases (NCDs), particularly in low- and middle income countries (LMICs) that are tackling these epidemics with insufficient resources.

Therefore the Ministry of Health in Rwanda through Rwanda Biomedical Center, Cancer Control Unit understands this burden and commits to join the world in the fight against cancer together with partners and stakeholders. Urgent actions must be taken to raise awareness about the cancer and to develop practical strategies to address its burden.

Despite the growing global disparities in access to prevention, treatment and palliative care, the government of Rwanda made significant progress in cancer control and providing treatment for all but the journey is still long as this burden grows every day.

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Minister of Health, Dr Diane Gashumba and
RCCR Executive Director, Jean Claude Mutabazi

Aligned with the 2018 World Cancer Day celebration, the Executive Director of Rwanda Children’s Cancer Relief (RCCR) - as a member of the Union for International Cancer Control (UICC) - held a one-on-one conversation with the Rwanda Minister of Health to talk about cancer control in Rwanda.

In this conversation, The Rwanda Minister of Health, Dr Diane Gashumba discusses with Jean Claude Mutabazi – Executive Director of RCCR – about Rwanda’s progress in cancer control.

Mutabazi: Cancer is a rising global health threat, from recent research, Cancer is deadlier than Malaria, Tuberculosis and HIV combined and this burden is projected to increase even more. As the Ministry of Health how are we prepared to address this challenge?

Dr Gashumba: I do agree with you, the entire world is facing an ever-growing cancer epidemic and if nothing is done the number of new cases is expected to rise by about 70% over the next two decades. Recent statistics are showing that more deaths are occurring in Low and Middle Income Countries (LMICS) due to late diagnosis and inadequate infrastructure to deal with the disease. Rwanda understands well this growing cancer burden and in our Economic Development and Poverty Reduction Strategy (EDPRS) II, cancer and NCDs are considered as a cross cutting issue that should be addressed to achieve a sustainable development of the country. In health Sector Strategic Plan III, cancers and NCDs are high on our list of priority disease. To address this cancer burden, the government has put in place structures at all levels:

  • Central and coordination level: In Rwanda Biomedical Center, we have established NCDs Division with a cancer unit mandated to coordinate all cancer control intervention across the country.
  • Service delivery level: We have defined package of cancer prevention and control services at all levels
    • Primary health care level: This level is mainly focusing on cancer prevention and early detection. Cervical cancer screening and breast cancer early detection services are available in half of health centers and district hospitals. HPV and HBV vaccines are being provided in all health facilities.
    • Referral hospitals: these hospitals are focusing on cancer care and treatment. We have five cancer diagnosis and treatment centers across the country. In few months we will have our first modern radiotherapy center that will provide a final link to currently available cancer treatment services (chemotherapy and surgery)

We have also prioritized palliative care as our patients are presenting at advanced stage, now palliative care and pain control medications are available in all health facilities.

  • Community level: At community level, we are focusing on cancer awareness using different communication channels and local authorities. We have recently initiated a new layer of community-based workers “Home Based Care Practitioners” that are dealing with NCDs awareness in the community and providing palliative care at home.

In brief, the country has put in place structures to deal with this cancer epidemic but they need to be strengthened to be able to provide quality cancer prevention, care and treatment to all Rwandans. With the continued commitment of the Government of Rwanda and support from our partners, we are sure that will reach our goal of having adequate cancer prevention, care and treatment services accessible to everyone.

Mutabazi: The current data we have in low and middle income countries is inadequate due to lack of cancer registries in many countries; this adds more challenge in cancer control. What is the situation for Rwanda in terms of cancer registries?

Dr Gashumba: In Rwanda, we do not yet have a functional population cancer registry; we are still relying on cancer information from our health facilities reported through Health Management Information System (HMIS). The Ministry of Health understands very well the role of Cancer registries in informing, monitoring and evaluation of cancer control plans and interventions. Establishment of a national cancer registry is a top priority of the Ministry of Health in cancer control; I am happy to tell you that we have already approved a plan to establish a national cancer registry, we can now move fast with the implementation. We are now quite confident that at the end of this year, we will have reliable cancer morbidity and mortality data in Rwanda.

Mutabazi: Does Rwanda have a National Cancer Control Plan (NCCP)? If yes, are we implementing it and what are the challenges so far? (If no, what is the reason and what are the plans to address this?)

Dr Gashumba: A national cancer control plan (NCCP) helps to implement systematic, equitable and evidence-based strategies for prevention, early detection, diagnosis, treatment and palliation using available resources. It helps people to be more organized and track the implementation progress of different cancer control interventions. Last year, with the support from International Atomic Energy Agency, we have initiated our first National Cancer Control Plan, the narrative is available and we are moving ahead with the costing. We hope that in two months from now, we will have our first NCCP that will enable us to implement well-coordinated and harmonized cancer control interventions.

Mutabazi: How is the role of private sector and civil societies in Cancer Control being measured in Rwanda?

Dr Gashumba: The global theme for this year's World Cancer Day celebration is “We Can. I Can.”, this highlights the role of everybody in fighting this cancer epidemic. Cancer is a cross cutting issue thus it needs cross cutting solutions, we need to have a multi-sectoral approach in addressing this issue of cancers and NCDs in general, we need to have everybody on board to combine our efforts in the difficult fight. The role of private sector and Civil Society Organizations (CSOs) is key in cancer control. We commend the role the private sector and (CSOs) are playing in Rwanda to support efforts of the government in cancer prevention and control. We need stronger CSOs and more private investment in cancer care and treatment. The government of Rwanda welcomes private sector to establish strong and impactful public private partnerships in cancer prevention and control.

Mutabazi: Recently Rwanda received radiotherapy (RT) machines that will operate from Kanombe military hospital, what Rwandans should expect from these machines?

Dr Gashumba: We have recently procured two linear accelerators to equip our first national radiotherapy center that will be located at Rwanda Military Hospital, this is a bold step in cancer care and treatment as radiotherapy was the main missing cancer treatment modality in Rwanda. Cancer treatment involves three main treatment modalities namely surgery, chemotherapy and radiotherapy, in most of cases, there is a combination of those three treatment options. We estimate that 50-60% of cancer patients need radiotherapy as part of their cancer treatment, the accessibility to those RT services was very difficult and expensive for our patients and the country as we were obliged to transfer abroad some of our patients in need of radiotherapy at a very high cost. We can now expect better treatment outcomes thus increase the survival rate of our cancer patients.

Mutabazi: We know that radiotherapy is expensive, are Rwandans going to pay this treatment?

Dr Gashumba: I do agree with you, radiotherapy is expensive as other cancer treatments but we make cost effective analysis; cancer treatment is cheaper than the cost of inaction! We used to transfer patients abroad at a very high cost, we are happy now that we will soon have our own facility and be able to treat our patients at an affordable price in Rwanda by Rwandans. The government of Rwanda considers health as a human right; we are working hard to improve the access to available treatments in Rwanda including radiotherapy.

Mutabazi: How are we progressing on public awareness of cancer and promoting healthy environments?

Dr Gashumba: Awareness on cancer and NCDs in general is still low, we need to double our efforts with the support of everyone, and Civil Societies Organizations should play a bigger role here. Public awareness should not be a one-time event, it should be continuous; we need to continue doing awareness using different communication channels until Rwandans have adequate understanding on cancer diseases and change their attitudes and practices!

I can say that we are doing interventions in promoting healthy environments in collaboration with different sectors. There are some tangible examples like the bi-weekly car free day in Kigali City and recently the initiative has been scaled up in other parts of the country, the mandatory sports activity for all civil servants is a good example of promoting healthy working place.

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The health sector has been prioritized through its integration into Rwanda’s overarching country development policies. There are measures, regulations and operational policies put in place so far to reduce risk factors for NCDs including cancer, the likes of banning water pipe smoking know as shisha, promotion of physical activities through car free days where the population get screened from NCDs, engagement of every stakeholder through social cluster ministries, strategy or action plan to reduce the harmful use of alcohol, strategy or action plan to reduce unhealthy diet and/or promote healthy diets.

With 60 per cent of cancer cases in Africa requiring radiation, Rwanda will soon add radiotherapy among available treatment options for cancer.

Most NCDs essential drugs are available and accessible. However, medicines for advanced NCDs treatment are not yet affordable to all patients.

To address this challenge of access to affordable oncology medicines that hit LMICs due to a high demand for oncology care in terms of life-saving medications, essential diagnostic and therapeutic equipment and skilled personnel, during the 11th International Conference on Cancer in Africa (AORTIC 2017) that took place from 7 to 10 November in Kigali, The National Cancer Institute (NCI/NIH) trained cancer leaders (including five leaders in Rwanda) on cancer control in Africa. Also Rwanda partnered with Bio Venture for Global health (BVGH) in their initiative of Africa Access Initiative (AAI) to sustainably expand access to oncology medicines and improve cancer care in Rwanda by coordinating delivery of medicines, technologies, and training.

“AAI is a powerful platform for expanding our international partnerships with the biopharmaceutical industry, training healthcare professionals, and delivering high-quality, affordable early detection and treatment services nationally—all of which are top priorities for our government as cancer rates continue to rise.” Welcoming Remarks from Dr. Diane Gashumba, Minister of Health, Rwanda.

Another big step was the announcement of the establishment of L.E.A.F Rwanda Ltd (L.E.A.F RWANDA) a biotechnology company that will operate from Kigali, Rwanda.

L.E.A.F Rwanda, a fully subsidiary of L.E.A.F Pharmaceuticals, will focus on establishing Rwanda as a hub for biotechnology Research and Development as well as pharmaceutical manufacturing in Africa.

Historically, innovative lifesaving medicines have taken too long to reach the African population, if at all. A key component of L.E.A.F. Rwanda’s mission is to focus on expeditiously making available such medicines to the African population,” Founder, President, and CEO of L.E.A.F. Pharmaceuticals, Dr Clet Niyikiza, said in his statement.

The new company in partnership with L.E.A.F. Pharmaceuticals anticipates making available its first anticancer medicine in Africa starting in 2019, it said. Develop and commercialize innovative and safe therapies for cancer.

Cancer control can’t be a task alone for governments and healthcare providers, everyone’s role is important regardless your background or field of work. We can as a collective or as individuals – can do our part to reduce the global burden of cancer.